I am aware of the benefits and side effects listed above for the bodywork service(s) included in this intake form. If at any point I experience pain or discomfort during my session, I agree that I will immediately inform my provider so that the session can be adjusted or postponed if medically necessary.
I understand that there are no implied or stated guarantees to the success of the effectiveness of a bodywork session. I acknowledge that my bodywork session(s) are not a substitute for medical care, medical examination, or diagnosis. I affirm that I have stated all my known medical conditions and answered all health history questions accurately and honestly. I will inform my provider of any changes in my health status and understand that there shall be no liability on the provider's part should I fail to do so.
I understand and agree that any illicit or sexually suggestive remarks or behaviors made by me, will result in immediate termination of the session and I will be liable for the full payment of the scheduled session. I am responsible for all charges for services provided at the time services are received.
